D-Tree International Who we are, what we do

D-Tree background Vision - A world in which every person has access to high quality healthcare Mission – To develop and support electronic clinical protocols that that enable health workers worldwide to deliver high quality care Founded in 2004: Currently 5 staff in US, 14 in Tanzania, 1 in Malawi and 1 in India 29/03/2011 CRS ICT4D Conference

D-Tree background… Health workers in clinics and community health workers are the front line of the health system, yet face high turnover and often have little training Challenges also exist in collecting and reporting data We build mobile applications to reinforce the training provided and to assist our partners in monitoring and managing the work that is done in remote locations 29/03/2011 CRS ICT4D Conference

What we do Develop or adapt clinical protocols in a mobile, electronic format Validate protocol effectiveness to ensure quality of care Design open-source software to support scale up and correct use of protocols Improve decision making through data and reports available across the continuum of care 29/03/2011 CRS ICT4D Conference

Continuum of Care develop / refine defined quality standards Neonatal Infant Care Child Dev. + Nutrition Adolescent Life Skills + Health Antenatal Labor + Delivery Post Natal Parenting Skills Family Planning develop / refine defined quality standards develop phone based delivery of standards to improve use monitoring tools of standards use for supervision patient data for quality improvement and links among providers data links to HMIS/DHIS for supervisors + managers D-tree Activites

Training and Pilot prep Our process Design Review of guidelines Observe patient flow Develop protocol Develop prototype Field Refinement Train small group of workers Weekly meetings to collect feedback Incremental application refinement based on HCW feedback Training and Pilot prep Train larger group of workers Complete central server set-up Pilot Monitor use of field applications Regular meetings with HCWs Validate reports Assessment Data analysis Measure effectiveness of application and interventions Lessons learned for larger scale-up 29/03/2011 CRS ICT4D Conference

TOSA Pilot Project - Bihar Our work in Tanzania, Malawi, and India… Chronic disease HIV/AIDS Diabetes Hypertension TB 3. Preventive Care Antenatal Immunizations Care and support 2. Child health IMCI Malaria Newborn HIV/AIDS Nutrition 4. Reproductive Health Family Planning Labor & Delivery Newborn 2/25/2019 TOSA Pilot Project - Bihar

Applications Community Facility Maternal and Child Health (Ante-natal, Post-natal, Neo-natal) TB screening Home based care Orphans and Vulnerable Children Family Planning Facility IMCI Active Management of Third stage of labor Immediate Newborn Assessment 29/03/2011 CRS ICT4D Conference

Software in the field 29/03/2011 CRS ICT4D Conference

Who do we partner with NGOs who are actively supporting the national and local government in their health programs NGOs who are interested in improving the quality of care and data collection in the areas where they work 29/03/2011 CRS ICT4D Conference

Role of partner Work closely with government partners at national, regional, district and facility level Provide subject matter experts (SMEs) or access to SMEs in other organizations to assist in protocol development Provide insight into local language and cultural practices, or access to those who can provide information 29/03/2011 CRS ICT4D Conference

Role of D-Tree Develop protocols working with government partners and SMEs Encode the protocols onto phones (java-enabled phones or smartphones) Lead the field refinement process and train users Adapt the software and protocol to incorporate the feedback received in the field Set up server and reporting for use by government and partner organization 29/03/2011 CRS ICT4D Conference

Partners

Pathfinder Developed mobile application to assist CHWs in the home visits for PLHA and Chronically ill patients Guide management of patient schedule visits Provide referral reminders for follow-ups all referred patients Deployed and currently used by about 150 CHWs in the field. 29/03/2011 CRS ICT4D Conference

Pathfinder… Focus group discussion Field Investigation 29/03/2011 CRS ICT4D Conference

JHPIEGO Developed facility and community protocols for antenatal, neonatal and postnatal care in accordance with Tanzania MOH guidelines Developed prototype applications ready for field refinement 29/03/2011 CRS ICT4D Conference

Treatment based on lab results JHPIEGO… Check for danger signs Treatment based on lab results Counseling messages 29/03/2011 CRS ICT4D Conference

UNICEF Developed protocols to support outpatient treatment of severe acute malnutrition in Zanzibar Developed application to support screening, registration, treatment and prescribing to be done at the health facility Field refinement and pilot to be completed by June 2011 29/03/2011 CRS ICT4D Conference

UNICEF… 29/03/2011 CRS ICT4D Conference

PATH Designed and Refinement of mobile app for District TB/HIV Coordinators (DTHCs) in Tanzania Designed and Refinement of mobile application for Community Volunteers to do TB screening in the community 29/03/2011 CRS ICT4D Conference

CARE-India Developed protocols for Individual Birth Planning and ANC, Active Management of 3rd Stage of Labor, Immediate Newborn Assessment and Postpartum follow-up for mother and child Establishing server for integration of all patient data in OpenMRS Application development and field refinement completed. 29/03/2011 CRS ICT4D Conference

CRS Malawi Assisting with three mobile applications to improve the quality of life for orphans and vulnerable children and people living with HIV Child Status Index Supporting OVC committees Community – IMCI Supporting Health Surveillance Assistants Mother-infant pair follow-up Supporting Health Promoters 29/03/2011 CRS ICT4D Conference

What we have learned Frontline workers quickly learn to use mobile phone based protocols Mobile phones can significantly increase adherence to guidelines Protocol development is a labor intensive, iterative process Linking patient information across space and time can improve quality of care 29/03/2011 CRS ICT4D Conference

Keys to success Willingness to try something new and listen to the field level workers Active engagement in the protocol development and technology support by all parties involved Incorporation of project into larger efforts so that this is not a stand alone “technology project” Understanding that this is not “out of the box”, but an iterative process which will get us all to tools that can have a real impact 29/03/2011 CRS ICT4D Conference

What’s coming next Linkage of community and facility based information and tools Incorporation of media (pictures, videos, voice) into protocols More in depth clinical protocols Improved supervisory reporting Reporting from OpenMRS 29/03/2011 CRS ICT4D Conference

Contact us http://www.d-tree.org Offices in Boston, Tanzania and Malawi Email: info@d-tree.org Phone: +1 617 432 6322 29/03/2011 CRS ICT4D Conference